| Midamericare Limited Liability Company | |
|
6301 E 125th St Grandview MO 64030-1884 | |
| (816) 516-7114 | |
| Not Available |
| Full Name | Midamericare Limited Liability Company |
|---|---|
| Speciality | Psychologist |
| Location | 6301 E 125th St, Grandview, Missouri |
| Authorized Official Name and Position | Craig A Erisman (PRESIDENT) |
| Authorized Official Contact | 8165167114 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midamericare Limited Liability Company 2900 Sw 13th St Lees Summit MO 64081-3800 Ph: () - | Midamericare Limited Liability Company 6301 E 125th St Grandview MO 64030-1884 Ph: (816) 516-7114 |
| NPI Number | 1922322676 |
|---|---|
| Provider Enumeration Date | 03/24/2010 |
| Last Update Date | 03/24/2010 |
| Medicare PECOS PAC ID | 4284768516 |
|---|---|
| Medicare Enrollment ID | O20100823000111 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922322676 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 2007006349 (Missouri) | Primary |
| Provider Name | John L Kostoryz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639256753 PECOS PAC ID: 9830168905 Enrollment ID: I20040927000738 |
| Provider Name | Jason Carter Fairman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417033895 PECOS PAC ID: 9830142348 Enrollment ID: I20050224000576 |
| Provider Name | Jennifer Darling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366506636 PECOS PAC ID: 5395754493 Enrollment ID: I20060418000686 |
| Provider Name | Linda L Simmons |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912927575 PECOS PAC ID: 6507866324 Enrollment ID: I20061229000408 |
| Provider Name | Craig Erisman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1154449676 PECOS PAC ID: 9638130867 Enrollment ID: I20080602000697 |
| Provider Name | Amie L Cooper |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386710267 PECOS PAC ID: 8628127396 Enrollment ID: I20090529000146 |
| Provider Name | Susan R Moline Reyes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548426117 PECOS PAC ID: 3971644485 Enrollment ID: I20100106000425 |
| Provider Name | Jennifer A Solas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891001269 PECOS PAC ID: 7012100712 Enrollment ID: I20101026000219 |
| Provider Name | Carol Ruth Childers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396993275 PECOS PAC ID: 3476748898 Enrollment ID: I20101111000481 |
| Provider Name | Crystal Lyn Brokering |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558671495 PECOS PAC ID: 6800081829 Enrollment ID: I20101116000259 |
| Provider Name | Tessa Jo Coltrin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255512778 PECOS PAC ID: 2264699586 Enrollment ID: I20120127000995 |
| Provider Name | Cayla L Malter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861730517 PECOS PAC ID: 8022255074 Enrollment ID: I20130510000150 |
| Provider Name | Merri C Hunter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982739306 PECOS PAC ID: 6608017959 Enrollment ID: I20130729000674 |
| Provider Name | Tara Michelle Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427090380 PECOS PAC ID: 9931331618 Enrollment ID: I20140411000531 |
| Provider Name | Richard Lin Welch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194128504 PECOS PAC ID: 3678793890 Enrollment ID: I20141009001759 |
| Provider Name | Jacqueline Brown-allen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245656602 PECOS PAC ID: 6507087772 Enrollment ID: I20141101000048 |
| Provider Name | Karanita Berniece Boling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477721306 PECOS PAC ID: 3971742149 Enrollment ID: I20160818002227 |
| Provider Name | Kerry Mcrae |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659829018 PECOS PAC ID: 8325335482 Enrollment ID: I20160919000219 |
| Provider Name | Robin L Larson-molzen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942283478 PECOS PAC ID: 6507130754 Enrollment ID: I20170927000213 |
| Provider Name | Nikki S Fryer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407140296 PECOS PAC ID: 8426317256 Enrollment ID: I20180123003529 |
| Provider Name | Margaret J Duckworth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780967208 PECOS PAC ID: 7810259090 Enrollment ID: I20180328001449 |
| Provider Name | Diane Hendricks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891223558 PECOS PAC ID: 9931462777 Enrollment ID: I20180410000437 |
| Provider Name | Claire Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891164885 PECOS PAC ID: 6800134784 Enrollment ID: I20190219002908 |
| Provider Name | Linda Vandivert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992261788 PECOS PAC ID: 3274872056 Enrollment ID: I20190222002519 |
| Provider Name | Michael Alphonzo Bryant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124096235 PECOS PAC ID: 3779534151 Enrollment ID: I20190521003099 |
| Provider Name | Dennis Campbell |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1336314582 PECOS PAC ID: 0749330017 Enrollment ID: I20190718000056 |
| Provider Name | Joyce A Gillis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871702910 PECOS PAC ID: 5193079879 Enrollment ID: I20191211001754 |
| Provider Name | Lakiesha Latoshia Mccrorey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295003952 PECOS PAC ID: 8325453533 Enrollment ID: I20210222001845 |
| Provider Name | Brandon Cher'awn Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417509324 PECOS PAC ID: 1759796741 Enrollment ID: I20210225001840 |
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